You are here: Diseases » Frequent throat clearing
Patients report that they constantly suffer from the feeling, which is difficult to describe, that there is something disturbing and constricting in their throat and that it has to come out somehow. They constantly feel the need to swallow or clear their throat. For some, it also triggers an urge to cough or shortness of breath.
The impairment is sometimes described as a feeling of pressure and lumpiness (so-called globus sensation), sometimes more as irritation of the mucosa with a foreign body sensation. Increased mucus with a viscous, unpleasant mucus is also complained of by some patients.
Of course, the affected people first contact the ENT and lung doctor. This makes a lot of sense, since a number of organic diseases in the area of the throat (inflammations, tumors, thyroid diseases, etc.) or the lungs have to be excluded. Medications and acid reflux from the stomach are also common causes of irritable cough and dysphagia.
Sometimes, however, nothing at all is found and now it often becomes difficult, since without a clear cause, a clear therapy is also difficult to find.
Our throat is - to put it somewhat casually - a single faulty construction. No engineer would first guide the esophagus backwards across the trachea and then develop a complicated combination of hardware and software to contain the self-induced danger of swallowing again.
But in our case, that is exactly what is happening. Due to coincidences in evolutionary history, the paths of food and airflow cross in the larynx. Therefore, nature had to develop a highly complex larynx including epiglottis and numerous protective reflexes, all of which must prevent foreign bodies from entering the lungs.
Food is not harmless! Every bite is teeming with germs. If these pathogens get into the lungs, life is in danger! One can imagine how essential the perfect function of the swallowing act is.
In humans, however, an enormous amount of effort is required for safe swallowing. No fewer than 26 pairs of muscles, 5 pairs of cranial nerves and 3 nerves from the cervical spine become active when you take a completely harmless sip of water.
The whole thing also needs to be trained early on. From the 15th week of pregnancy, the unborn baby begins to prepare for this difficult task. And shortly before birth, it is already diligently swallowing just under half a liter of amniotic fluid so that it is perfectly prepared for the mother's milk.
Swallowing is by no means only necessary for food intake. We also have to keep the food passages clear and repeatedly remove the hydrochloric acid that has strayed from the stomach into the esophagus.
So we have to swallow quite a bit during the day and do so about a thousand times - day after day. By the time we reach retirement age, we will have swallowed around 25 million times, all of which must be completely error-free, otherwise we will hardly be able to enjoy a carefree retirement.
Errors occur in any complicated system. We then call this "swallowing". The greatest danger is when a foreign body is not recognized and then also gets into the lungs. In contrast, an unnecessary triggering of the various protective reflexes is harmless.
Irritations of the most varied kind can trigger reflexes that are too fast: These can be foreign bodies, irritants, gases, odors, fragrances, or irritation of the mucous membrane by viruses, bacteria, or fungi, organic changes in the throat region, or even impairment of the nerves involved.
Also a general mental tension triggers the reflexes more easily. We show a "nervous cough" when we feel unwell. The body confuses the mental with a physical threat. The motto: Better coughed once too much than once too little!
Disturbances can be triggered on several levels.
Different levels of protective reflexes can be distinguished. In the beginning, there is the recognition of danger: the sensory system. Intruders and foreign bodies must be detected. This requires constant sensitivity. If the danger level increases, the warning systems may be set too sensitively and false alarms may occur.
This leads to
The aim in each case is to prevent the penetration of threatening substances or to remove them from the body.
If the mucous membrane is impaired, it also triggers a protective reflex: increased mucus production. Again, there are numerous causes (germs, injuries, etc.). But also increased tension can lead to mucus. Sometimes this is then a particularly tough mucus that forms in the nose or throat.
Even more important is the motor response. Depending on the danger, the solution is to eject or swallow. It consists of rinsing, coughing, clearing the throat, and swallowing laryngeal closure. All of these measures are ultimately powerful tools to effectively combat danger.
As a rule, protective reflexes aim at a lightning-fast solution to an acute danger (suffocation). But if the helpful reactions are triggered again and again, this can lead to problems. Continuous coughing, continuous coughing, continuous swallowing, etc. irritate the very structures that are supposed to protect us.
This, in turn, triggers coughing, swallowing, throat clearing, etc. The vicious circle is perfect, and the longer the symptoms persist and the higher the accompanying anxiety/tension, the more difficult it becomes to escape.
The normal emotional reaction to the threat of suffocation is called panic. And this in turn leads to a change in breathing with hyperventilation. If the feeling persists over a long period of time, then chronic hyperventilation with numerous other symptoms can develop.
Phagophobia or swallowing anxiety is the fear of swallowing. This is usually accompanied by a fear of choking (choking phobia) and should not be confused with globus hystericus or anorexia nervosa. In addition to the fear of choking on food, there may also be a fear of swallowing saliva.
We have been working a lot on this problem in the last few years and have developed a therapy method for it.
The most common risk factors for one of the above complaints are:
In some cases, the treatment is simple. It is enough to soothe the mucous membrane. Lozenges (sage, menthol, eucalyptus), chewing gum, oily nose drops and also inhalation (water vapor without additives) are one of the options. Herbal preparations such as ribwort, thyme, drosera or woolly flowers can provide relief.
Anesthetizing the overstimulated nerves can also be helpful. Lozenges containing lidocaine, a local anesthetic, are suitable for this purpose.
Medications that have a depressant effect on reflexes can also be useful: Cough suppressants (e.g., with codeine), antidepressants (e.g., amitriptyline), or drugs for epilepsy. Sedatives should be avoided if possible because of the problem of dependence.
Non-drug therapies include physiotherapy, respiratory therapy (especially for hyperventilation) and speech therapy.
In many cases, a therapy that is narrowly focused on the symptom is not sufficient. It may even be that an intense preoccupation with the problem in particular draws attention to the reflex so much that it is triggered more often as a result.
Then it is necessary to first re-establish a general feeling of security and well-being. Soothing words are not enough for this. The body has to feel close to the skin and comprehensively that there is no danger.
To achieve this, we first use a combination of calming, relaxing procedures: massages, heat, pleasure and relaxation exercises. Focal psychotherapy can also be very helpful.
Breathing and swallowing training, physiotherapy and hardening measures are the second pillar of therapy. The body should learn when the reflexes are useful and when they are not. It is therefore a matter of a new "calibration" of the processes. In this way, the disturbed reflexes should calm down and normalize again.
Which procedures are used in which combination depends on the individual case.
After a lot of effort, everyone is tired. After rest it gets better. However, there is a feeling of exhaustion, neither sleep nor vacation will not help. It is a great need for rest with simultaneous restlessness. Terms like CFS, burnout or exhaustion syndromes do not help.
What is behind it? What helps?
Panic attacks and panic disorders are referred to as a subtype of anxiety disorders. They come suddenly "out of the blue" and are accompanied by fear of death. Most sufferers experience primarily an intense physical threat and are often surprised when no physical findings are raised . Many are skeptical when a purely psychological disorder is assumed. In fact, new insights into the organic background of panic are leading to innovative, effective therapies.
While the acute hyperventilation syndrome is a highly acute complaint (shortness of breath, anxiety, palpitations, dizziness, panic), the chronic hyperventilation syndrome is often overlooked. It usually manifests itself only indirectly and often only after years of symptoms. However, the consequences for the quality of life are sometimes even more serious and often lead to severe impairments, even to retirement.
Dizziness, that means a disorientation in space. There is hardly anything that is as unsettling and causes fear, even panic, as this sensation.
For some types of dizziness there are clear findings, e.g. an impairment of the inner ear. An example would be benign positional vertigo, the most common type of vertigo.
But sometimes there are no physical findings at all. Often it is more a feeling of dizziness, a feeling like being drunk or having absorbent cotton in the head. Usually it is coupled with strong exhaustion, sleep disturbances and numerous further complaints. Then the insecurity is twofold: Once by the discomfort and then still by the lack of clarity, what then causes this discomfort.
These pages are about dizziness with and without physical findings. What is it? How does it occur? What to do about it?
Patients report that they constantly suffer from the feeling, which is difficult to describe, that there is something disturbing and constricting in their throat and that it has to come out somehow. They constantly feel the need to swallow or clear their throat. Some also experience an urge to cough, shortness of breath or even panic.
Dr. med. Thomas Weiss
P 6, 26
68161 Mannheim
Office hours:
Mo. – Do.: 9.00 – 16.00 h
Fr: 9.00 – 15.00 h
Phone: +49 621 460 860 60
Mail: info@weiss.de
